GOP health plan could be road to nowhere
By: John Bresnahan and Jake Sherman
March 18, 2014 06:00 PM EDT

Here’s the dirty secret about the House Republicans’ efforts to replace Obamacare: They haven’t even decided if they will hold a vote.

Not to mention, the House GOP would still have to repeal Obamacare in order to implement whatever alternative health care plan they release, which isn’t going to happen as long as President Barack Obama is sitting in the Oval Office.

In the next few weeks and months, the House Republican Conference — with Majority Leader Eric Cantor (R-Va.) playing the key role — will spend lots of time talking about crafting its own health care plan, one that would be positioned as an alternative to the 2010 Affordable Care Act.

But with a Republican alternative to Obamacare come serious practical and political problems that could prevent the legislation from even getting to the House floor. A critical midterm election is just a few months away. Public opinion is firmly against Obama’s health care law, and releasing specific bills could take the focus off the Democrats’ squirming.

Republicans aren’t even convinced they will find consensus on any specific set of new health care bills. The ideas they’re discussing — the ability to buy insurance across state lines, wider use of health savings accounts and cutting federal regulations — are the same principles they have kicked around since 2009. But the party is not much closer to finding a proposal — or set of proposals — that would garner enough Republican support to pass the House.

Not to mention, some of the policies the GOP is considering — including state-based high-risk pools — already exist and don’t work very well. Endorsement of these policies by the House Republican Conference could leave Speaker John Boehner (R-Ohio) and his leadership team open to heavy political fire from the White House and Hill Democrats.

They also have to contend with a tough set of political circumstances — including their colleagues on the other side of the Capitol dome. Three Senate Republicans — Richard Burr of North Carolina, Orrin Hatch of Utah and Tom Coburn of Oklahoma — have offered a proposal to repeal and replace Obamacare with “market-based reforms,” mainly in how employer-based health coverage is taxed. The Republican Study Committee, the leading group of House GOP conservatives, has its own plan, as does Rep. Tom Price (R-Ga.).

Furthermore, several senior Republican lawmakers and aides suggested it’s a mistake to allow vulnerable Democrats a vote on an alternative to the current health care law. Following Democrats’ disastrous loss in a recent special election in Florida — partially due to Obamacare’s continued unpopularity — some Republicans aren’t eager to give Democrats a way out. Obamacare, these Republicans say, will play a major role in the 2014 election, and a GOP alternative will only distract from the Democrats’ support of Obama’s signature legislative achievement.

There’s even a concern about how Republicans would brand this effort: They don’t just want to “replace” Obamacare, because they believe Obama’s approach is flawed and needs to be repealed outright. Instead, Republicans say they must offer their own market-based solutions, rather than government mandates.

Cantor has verbally committed the party to a vote and, behind the scenes, is driving House Republicans in that direction. Pushing an alternative falls in line with Cantor’s push to market the party as a legitimate alternative to Obama, not just knee-jerk Republican opposition to the White House.

“The majority leader supports moving legislation,” said Doug Heye, Cantor’s deputy chief of staff. “Discussions on this [package] are still ongoing, both on policy and on process.”

Cantor has been working with several of the top Republican committee chairmen — including Energy and Commerce Chairman Fred Upton and Ways and Means Chairman Dave Camp, both of Michigan , and Education and the Workforce Chairman John Kline of Minnesota, among others — to assemble proposals for a GOP package.

The idea is to have the chairmen build support for any alternative proposal from the “inside out,” meaning using the committees and their chairmen to help increase the vote for a health care alternative long before it gets to the floor. Translation: This could take some time, and things get only more difficult as the election draws nearer.

It’s not clear which panel would take the lead on cobbling together a package, or whether all the committees would mark up their own proposals, with the Rules Committee taking over the job of assembling the final bill. That option that would give Boehner, Cantor and other party leaders the most flexibility.

“Is it one bill? Is it a series of bills? Nothing has been really been discussed on that in any substance,” Heye said.

House Majority Whip Kevin McCarthy (R-Calif.), who will have to round up the 218 votes for passage, wants to make sure the party is ready to vote on an alternative, if and when it comes to the floor.

At this point, Republicans aren’t closing in on any firm details of what they want to enact but, rather, are searching for some common ground. The party is shuffling through roughly a half-dozen health care-related bills and seeing what takes hold. McCarthy and House Republican Conference Chairman Cathy McMorris Rodgers of Washington will host a planning session at some point in the next several weeks. Several Republican lawmakers who are doctors are involved in these talks as well, GOP sources said.

Republican leadership started preparing lawmakers to consider a health care alternative at the House GOP’s January retreat in Cambridge, Md. During that presentation, they laid out ideas for a GOP overhaul of the health care system — including medical malpractice reform; repealing the Sustainable Growth Rate, medical device tax and Medicare’s Independent Payment Advisory Board; implementing protections for consumers from insurance companies canceling plans due to preexisting health conditions; and promoting medical research.

Potential timing for floor votes is a challenge as well. If there is only one large bill, that would affect when the GOP legislation could come up for passage.

Republicans could string out the vote until early fall, hoping to provide the maximum leverage over vulnerable Democrats in swing states. “The politics of this could get very interesting come September,” acknowledged a top House Republican aide. “If Obamacare is still really unpopular, then that would really help us. … But this is still being worked out.”

Democrats, for their part, are hoping support for Obamacare continues to grow. More than 5 million Americans have signed up for health coverage through the federal and state health exchanges since Oct. 1, the Health and Human Services Department announced on Monday.

But a senior Democratic strategist involved in House races said, if Republicans adjust their message from repeal to “we need to get rid of 80 percent of the law, keep some stuff, you’ll start seeing them pick off a lot of Dems at that point.”

“The only thing we have going for us is [Republicans] insist on full repeal, even the breast cancer funding,” the Democratic strategist said. “If they scaled down to something more reasonable, they would beat us every time.”